Peripheral
Femoral bifurcation
PAD with highly selective treatment for CLTI
This case was presented at JIF Periph Live on 14 December 2024 by the University Hospital of Bordeaux
Part I - Case presentation
An 83-year-old patient with:
- Coronary disease / valvular disease / atrial fibrillation / diabetic status / dyslipidaemia
- Previous EVAR in 2011/ TEVAR in 2013/ complete femoro-popliteal stenting in 2017/ TAVI in 2023
- Clinical worsening status with Rutherford IV on left side
- Recent investigation with angio CT scan and per operative angiography showing:
- Aorto-ilio-femoral patency associated with profonda thrombosis to distal reinjection branches, and superficial femoral and popliteal arteries thrombosis with reinjection on tibial arteries
Per operative angiogram of the left leg
- CFA patent
- Stump for SFA
- Thrombosis of the PFA ostium
- Collaterals for distal perfusion
Per operative angiogram for the left leg
- Very slow flow
- Distal reinjection on BTK arteries
- TTP reinjection with peroneal artery
- TA reinjection with slow flow
Part II - Our decision
- Brachial access for endo treatment of the left leg (through previous EVAR)
- PFA recanalisation
- +/- SFA recanalisation
- Distal control at reinjection zone with improved flux
- Decision to stop at this point without SFA recanalisation after a 56-minute procedure
- Patient discharged at D+1 with Rutherford Class IV to RC II/III at 1 month and same RC II status at 6 months post intervention (mai 2024)
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